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on november the 27, it specifically mentions a section, 1311 of aca, which directs quality health plan issues and improvement strategies as directed by the secretary, specifically subsection 8 of 1311 would allow the secretary to prevent physicians treating patients in exchanges unless they implement such mechanisms to improve health care quality the secretary may require. physicians must follow quality directives as defined by the secretary or lose their business. mr. smith, are you aware of this provision? >> i am not familiar with that section. >> let me ask you this. in this provision, you may not know this either, but the word quality is not defined in the statute. it is safe to assume that the secretary, not just secretary sebelius, but every secretary to follow, would be able to define for regulation what that word quality means. yes or no? >> i believe that is the correct interpretation. again, we have tried to introduce quality performances into a variety of parts of our programs, both in managed care, both in the fee-for-service world, and this is another one of our concerns that we
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wio p cajut n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain arasnd® pcis rid -pre.®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! >> wme. w texsdw nkreha ton esceoe f buit >> aitallan rete i'reko a rtn es pso ri. k uti. to we lng a t stceivor buit thre mcece d q iadth -p lof. ins udnscrhe b gho mmety >>uc my s r usthyoo atndhaad ioeyis ttrk m iewjech i ofophrie i eud theachsys. ti nbodsnd oromngiseakt on oe ps iv w leea theho o edak etrara mian ul om ttrara ch. heein sts trg t f ns in isup ieao se dondakhese a me li oomtys imanem theo lo t ho p api thovcks,be babaoo eyueua t w t ve in h'sak i yownya a gun cao
tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 oftintpececkn ef ®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! >>e'th coticoy . isiny eperf ift ertias iccoth ao m >> vitgi y outo iypeou w bn tat s wno a tn ye us whegiis a e chn st. isa t etag ac th ief ror rees i tim quholyelw uhel tl ia r hef evg. thar h b on olre ar s it bifief ak bad ape 90y s tc i canded ca vehuups keno e mea. om tasit ismitn i oid of h. ovis rec oe hi cngt' btnd lianarer l cit 's bn h la stonouaid vebl rd ths eest re. d oeraon t meerda eng dk wn toe bachsic oround. an fly womo er storpaf prty e a bifdo plwhwendan evgsallgh
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a loss so vast. the aca is not just above the expansion of medicaid or establishing an insurance exchange, it is about the hundreds of federal mandates and procedural requirements that have the escaped public attention, but to which we by law must obey. the fine print of the legislation is so complex, even the federal government struggles to understand it. the states cannot fully understand the impact on finances, systems changes, and operations. this law completely overwhelms society's safety net for the needy. there are a few problems in pennsylvania created by the aca. the law mandates that we expand our provider enrollment system to check with their medicare data. medicare databases cannot handle automated changes. we will have to add staff resources to respond to 100,000 inquiries every month. we are mandated to create separate databases to accommodate is exchanges and some databases like the masterfile, we have not been given access to. we adopt past medicaid rules radically changing the tailor- made renewal system that took years to refine and perfect. the verification system will
is the creation of health care exchanges. now, let me explain. these aca exchanges are online marketplaces. in short, websites. the idea is to force insurance companies to play by the same rules and compete for a large pool of customers resulting in less expensive premiums for everyone. here's how it works. let's say you're one of the 50 million people in in country without health care. you're looking to get yourself covered. you'd log on to your state's exchange or call a hotline number. the goal is to shop around for whatever plan works best for you and your family. if you are living at 138% to 400% of the poverty line, that is a family of four living off an annual income of $31,809 to $92,200, then you are eligible for government money to subsidize the cost of your premium. if you're above that level, you don't get the federal subsidy. the law requires every state to have a place for people to shop for coverage. there are three options on how they are created and operated. >> first, states can set up and run their own exchanges or if they're not quite ready to tackle is on their own, st
. i u tor wio p cajut n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 pcis rid -pre.®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! el ben us ne wncah rirt foto ly ho shhewshed cl'sldves spiorhiacr hi iebintmeb hantr dn p. om turry luho avat tim elad lcto g ro ithetxcgoo thusitt potmth e. rccte h er bede nc. whdi wt? rtnceg. eithte gnjeasend ndsearct ctverohe woan bhtse h weend des nd s el quigrkul ha atee. th wwe hin e t . e ng r drl. wns. iglu haso drcct entd akitbire teind las nd weddnt mreas epdheanh stilrkndxo on e e das lf . anut a tet e plio e gnuttoan thlaas the s in sl tohebs i sle ee
n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 pcis rid -pre.®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! >el b t " e. xtgoin df a stngveroomn icwi ang itrailhi adpasurde bymagas. ♪ >>, snn ag 'r0 mthth y n turfak fo, t sou a befuni 10 retalume a16 nogrba . t'ke a. een ur viro. ok tma tr. oy ieang eroo rnt h thhohirsle ma encto t li rlloee ent bar wor cngin bh ngs. eer ieedm th fyro hyoour ree,rain fl ll t aua pm arond ca ineonj y rirten m crt e heattu oe hos ck cng i y . udn ia ris an deabry t- thed r w n cote wit ydu vete a w wh c cetit m fr tinol emndsfou sp ths felao rtyoam a
edth rnbee acrtba slnu bnf tu. i u tor wio p cajut n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 pcis rid -pre.®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! >> wmeac t " e. w o nd d o thevornux rkew. istugarec bif a se al ies hry . hrro amerhiagce thevan iux pa norndanai syoou buin22 t ces. heouecknas chen h dg d iin ld wero o f end ed hout tif w enerhee, y iwhs ala tur ewa w a bif ni t l uprs p t ift ld s ow ♪ h o star al rwc tt ern fo dg . shgita clg ril de, ofev fiacitig ma o fit ps i en h trest nowhovokhe l anseo tkin. etutoo in tnt hs ng . yove ona ld s neanstreel meephhi is-cdte
two-step rocking. find out if your favorite leaves a big aca as it all happens live monday on fox. >> the news tonight is far from over in. >>> the the news edge at 11:00 starts right now. >> this is fox 5 news edge at 11:00. >>> a woman and child have been shot on a metrobus. the woman has died. the little girl is badly hurt. >> police aren't sure, but they think the child was the woman's daughter. fox 5's karen gray houston has more on this story from southeast. >> reporter: this southeast community is shaken after a man shot a woman to death on a metrobus and left a small child injured and hospitalized. police are desperately seeking the public's help to find the killer. the b2 bus had stopped at 18th and minnesota to pick up passengers. police say the unidentified woman had just taken the child out of a stroller. a young woman who was on the bus at the time but did not want to speak on camera tells me just as the two got on board the man she thought was a boyfriend stepped into the well of the bus, pulled a gun out of his pocket and started firing. that woman tells me bullets
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int edth rnbee acrtba slnu bnf tu. i u tor wio p cajut n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 pcis rid -pre.®0%orrecehed s.® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! > gh o1sok ohy iug ady ybu'otng t kn pt pfo unsaleon >hee'oo dr hrin riau, in s meleoome tot e lng a ben cngm nd nt tohi ar ioi l ahir a hokiysro n otha a tef 'mhedesi thviyl. ic"t " on ni ias n fate droer ioitc an l i >> kenonsouh t chthrezils oun tc hech c o in hari cgr,nd mot hhe kin. glouhe whrema? ee watesnd vi ack a spl ri >>ikri itveayhaue aeb cnor . tyl. ll c b [ ht >>e. algh t't ken a te wrtin 'roio t whe ersqavec ites age
ane. >> i ha tle int edth rnbee acrtba slnu bnf tu. i u tor wio p cajut n tof aca le moor d hee t tor, elat if hbaaiss tatht wap d nertheemb d d oulu. slnu b se i's behiro idsut puu intrf fiss thd er fupbee s stdeento r ueepbe rehain rech f: 9 pcis rid -pre.®0%orred s pa ® fas fr end dsl stsuiealisbew. l udfrvd d hubohe slnu bncng esd lss ee sgsd. anw t ? l ngn e cotaprrent theembed nt tury. aghood'lfeheurcl reanu ia s!i't ak eo'm ak en slon s er mf i hi rmet ll mti.neno rn ll e p er c abthmean rsg la e on iu teettr rf bacalw. tumonr en yfr foiot d brre p l caigow yl rve50in rdt ininoue p er.asour -f ign- t.caow yfrfoiot a $5vica ll! onre sfyou eeotitos deouss. inicplreus goutor t ti goug le fgh ahe h inemanur bu ] itit a0 m. d lahinys kibosug tst knwh thcasetl r . i o bse w t mahe'sor aite biee glri ifftg saoutshef et uevo coat. e dnureew akses,s rk s ou in h w do atlrl >> s't ep b amouar >> g osy eneint ni :0:0 >>nkor lng o ea maoutsy. mg , ngm, nig ut sple erng yohiryrn aay ng llrn wete tt onthssu itim m aci hn >>t engo dst t . isouasisou the
that must be covered by any health plan offering a plan in the aca exchange. i understand this has far reaching consequences on premiums. benefits must be provided. according to the notice in the federal register, the rule was approved by administrator on august 1, 2012. that is three months before. yet the role did not receive approval from secretary sebillius until two weeks ago. what did it take two month for the administration staff to review -- and yet the public will have only four weeks to review during the period of public comment on the ruling issued on november 26? i would note this is a time of year when people's focus is generally on things other than long awaited rules. >> we put a bulletin on the essential health benefits quite some time ago and got comments on the bulletin. the public had an opportunity to provide public comment on essential health benefits before the proposed rule was put out. there were some changes from what had been in the bulletin, but by and large what is in the bulletin is what is a in the proposed rule. i think there has been ample opportunity fo
'll see a cut to health care. the -- plan to actually put the aca into place simply cannot go through with this plan. so we're talking about real cuts to folks' real lives. that's an important point of what's going on. >> fair enough. really more down the road. you heard ben jealous worry about that. let me just ask you -- >> the aca is going to raise health care costs monumentally. >> that's not a budget -- >> yes it is. >> reduce costs for consumers and cut the budget deficit by 1 $180 billion. what's the base of your projection? you're pulling it out of the air. >> no, i'm not. the congressional budget office keeps making costs increase from what they originally projected. now that various individual plans and firms are costing out what they're going to have to do, you're saying far more firms are going to be not covering people. this plan was conceived in a way that didn't understand the economic consequences. >> just to the clarify, the aca, obama care. >> yes. the affordable care act. >> basically protects -- >> anything but protect patients or be affordable. it is orwellian. >
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the marine terminal at pier 41 was part of the acas i say and in 2,007 the blue and gold receive the iso31 in service and the safety management service was certified by the america bureau of service and this is was a huge complicate for the company. one that everyone contributed to. and it brings us to 2012 under the contract blue and gold operates and maintains 11 vessels owned by l e t ta and blue and gold operates clues and is maintains nine vessels four of these vessels are capable of speeds of 40 naughts, they are hain contained in value lay oh, by blue and gold employee and is so successful are in the ala media oakland and harbor bay and the newest san francisco ferry service and the remaining eight are operate in the excursion business bay reuses, charters and our rocket boat we operate to tib bureau ron, angel island and our commuter ferry service to tib bureau ron and the 15 services are all maintained by blue and gold feet employees at our pier nine facility in san francisco. i don't believe this slide needs much explanation these are the public agencies who over see our operat
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recovery. in terms of health care costs related to the aca, while most business leaders that we have spoken to have said is they understand we needed to do something. small-business owners are impacted disproportionately by rising health-care costs. the current health c arpl work for them less well thanlarg companies because they don't have buying power. if you look at some of the reforms, you see a number of efforts to try to reduce costs for small businesses to, like creating exchanges, for example. small in 2011, small businesses paid 25% more for insurance than large companies. the exchange is meant to help small business. you are right. with the new regulations set to take effect in a couple of years, it is another reason to be careful and protect small businesses from tax increases. what the obama people will tell you is that they have cut taxes for small business 17 times and 90% of the small businesses in america would not be effected by higher individual taxes. host: here is "the miami herald" this morning. pennsylvania. independent caller. caller: he said it earlier when they go t
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. analysts believe the generic drug makers could see a 40% jump in revenues once the a.c.a. is fully implemented. >> if you look at where a lot of companies are focused today, it is in the disease states that are relevant to an aging population. >> reporter: new drugs and new markets may help spark revenue growth, but the 10,000-pound gorilla is a newer category of products known as bio-similars, which are proteins made in living cells that are oftentimes used to treat cancer. they are a lot more difficult to copy but could also carry fatter profit margins. ruben ramirez, "n.b.r.," new york. >> susie: on wall street progress on the fiscal cliff negotiations srkedroad-based gains on wall street, helping the major indices close at post- election highs. the s&p 500 rally got going about an hour after the homebuilders confidence survey was released, moving higher for an eighth straight month. the s&p finished up 0.9%. trading volume picked up. 817 million shares moved on the big board, just over two billion traded on the nasdaq. nine of the ten major stock sectors were higher. energy and
to bring the a.c.a. back into the negotiations for some is wild read. you still see the same kind of intrancy generals. wait a minute, who won this election? this mandate is mine. i earned it. 3% i won a national vote by 3% which in modern times is a landslide. we won seats in the senate. we took seats in the house. >> the house, if there were no part in the jerry man derring, that's as important as energizing the base and getting some move in social media. >> at the same time, they have to get a number of votes. they need 218 votes in the house. part of the art of washington politics is giving your opponents something to run against you in the next election. >> what they have to give house republicans is something they can take back to these very conservative jerry man der districts. it is not as if most people are running in swing districts. most are running in hard right districts where they can get a primary challenge. the reason you are hearing boehner ask what are you going to cut? they want the president to put some ideas on the table. all of the bad ideas, they are all com
are trying to do that, implementing thea aca. i feel strongly of rewarding doctors differently, in a way that rewards success. in those discussions, are there other ways we can see revenues come in from within the health- care system? i think that is on the table. i am not keen on raising the age for medicare. we have to help figure out how to a group of people figure out how to get health college. that is the cost of subsidies. do they go into the exchange. for medicare, the use of the least expensive seniors we have, 65 and 66 year olds. the most expensive seniors are much older. you have to look at the consequences and whether that is a cost savings at the end of each day for government and for families. >> one final question on the immediate and we will go back to the broader agenda. the president had a firm statement this week about the test ceiling where he says, i will not play that game, meaning he will not negotiate for raising the debt ceiling. how was that going to work? does that need to be part of any agreement to appoint -- agreement to avoid the fiscal cliff? >> this is se
for whenever subsidies they been entitled to. it'd different story for the medicaid expansion. the aca specifically does limit eligibility for the new medicaid coverage to people under 65. presumably there would need to be a statutory change if medicare eligibility age was raised to 67 or even higher, that provision would need to change to enable people to qualify for the medicaid expansion. in states that don't expand medicaid those adults with incomes between 100%, and 138% of poverty would be eligible for subsidies in the exchange and they would be subject to the mandate, but for people with income below 100% of poverty in states that do not opt for medicaid expansion, they would not be eligible for medicaid or subsidies because the law limits those to people with incomes 100% or above. having spoken to my colleagues at kaiser about this issue who followed this issue more carefully than i have, they said cygnus -- secretary cbs has said these individuals would not be subject to mandate penalties if they lived in a state that did not expand medicaid and selling this coverage gap. >>
at the internet and say do we have to draw lines here? have we gone too far? i personally think my position on a.c.a. is a good position and protecting the people's right to know is a high priority. >> what have you decided to do with all your papers and years in congress? >> that is an important question. i'm pleased to say that my alma mater at ucla is taking some interest. hopefully, some of that work will be of value to researchers sometime out there. >> you have expressed optimism and interest of what your future might hold but it has to be difficult leaving this institution after so many years. this has been most of your adult life, your way of life. how are you using these last few weeks here, still as a voting member of congress? is the experience -- does it feel different saying this might be the last time i will do this? >> i was looking at my cad and wondering how many more votes i have left. if i thought this was the end of impacting public affairs i would be very nostalgic. we're looking at it as another chapter in life -- the book of life that we look forward to. >> do you plan to make
the economic recovery. in terms of health care costs related to the aca, while most business leaders that we have spoken to have said is they understand we needed to do something. small-business owners are impacted disproportionately by rising health-care costs. the current health care plans work for them less well than they do for larger companies because they don't have buying power. if you look at some of the reforms, you see a number of efforts to try to reduce costs for small businesses to, like creating exchanges, for example. small businesses in 2011 paid about 25% more for health care insurance than large companies. you are right. with the new regulations set to take effect in a couple of years, it is another reason to be careful and protect small businesses from tax increases. what the obama people will tell you is that they have cut taxes for small business 17 times and 90% of the small businesses in america would not be effected by higher individual taxes. host: here is "the miami herald" this morning. pennsylvania. independent caller. caller: he said it earlier when they go to wa
is the first to look at the effects of increasing medicare eligibility age in the post aca era. and that's important because it to scare some extent alleviates the concern that tricia mentioned that people who lost their eligibility for medicare would lose access to health insurance entirely. under the law they would have access to new sources of coverage. so our study also goes beyond some of the other analysis to look at the effect of raising the age of eligibility not just on federal spending and medicare spinedding but also on state spending, on out of pocket costs for the 65 and 66-year-olds who shift out of medicare, on employer cost, on cost for part b. premium for remain. on exchange premium for younger enroll lee as well as the totalling health spending effect of the changes across the different payers. we estimated that about 5 million 65 and 66-year-old would be affected. we assumed that all would have coverage from another source if not from medicare the supreme court decision to make the medicaid expansion optional calls this an assumption in to question to some degree. in t
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